Various patents and other publications are referred to throughout the specification. Each of these publications is incorporated by reference herein, in its entirety.
Various publications, including patents, published applications, technical articles and scholarly articles are cited throughout the specification. Each of these cited publications is incorporated by reference herein, in its entirety.
In the United States, about 795,000 people experience new or recurrent stroke. About 61,000 of these are first attacks and 185,000 are recurrent attacks (American Heart Association, Heart Disease and Stroke Statistics Update 2004). Preliminary data from 2006 indicate that stroke accounted for about one of every 18 death in the United States (Heron et al. 2008. National Vital Statistics Reports 56:16). On average, every 40 seconds someone in the United States has a stroke. Preliminary stroke mortality in 2006 was 137,265 and the preliminary death rate was 43.6%.
Two of the most common strokes are ischemic and hemorrhagic strokes. In ischemic strokes, a lack of oxygen flow to the brain can result in apoptosis and necrosis of brain tissue leading to an infarction. Similar to cardiovascular ischemia, brain ischemia can be caused by various factors such as blood clots, thrombosis, embolism, blockage by atherosclerotic plaques, or other obstructions in the vasculature. Hypercholesterolemia, hypertension, diabetes, and obesity, among other things, have been identified as risk factors for ischemic strokes. Ischemic strokes are a leading cause of death of human beings worldwide. A ruptured blood vessel in the brain typically causes hemorrhagic strokes, which account for between about 10 and 20 percent of all strokes. The rupture causes bleeding into the brain, where the accumulating blood can damage surrounding neural tissues.
The stroke episode, regardless of its cause, results in neural cell death, especially at the location of the obstruction or hemorrhage. In addition, biochemical reactions that occur subsequent to the stroke episode in the vasculature may lead to edema, hemorrhagic transformation, and a further compromise in neurological tissue. The neurological damage and neuron cell death that result from a stroke can be physically and mentally debilitating to an individual. Among other things, a stroke can result in problems with emotional control, awareness, sensory perception, speech, hearing, vision, cognition, movement and mobility, and can cause paralysis.
The current treatment for ischemic stroke, tissue plasminogen activator (TPA), while efficacious, is only effective if it is administered within three hours of the ischemic event. Therefore, treatment with TPA remains inadequate for patients who are unable to be diagnosed and treated within that time frame. TPA is also not appropriate for patients who suffer a hemorrhagic stroke. Considering the limitations of TPA and the high mortality rate of stroke patients, there is a clear, unmet need to reduce mortality rates, restore neural function and extend the current window of therapeutic opportunity. Effective treatments will have to have a wide window of therapeutic opportunity, address the neurological damage associated with stroke and reduce disabilities that severely reduce quality of life for stroke patients. Cell therapy, a novel approach to treating stroke, may offer significant health benefits to patients.
Neurological damage and neurodegenerative diseases were long thought to be irreversible because of the inability of neurons and other cells of the nervous system to grow in the adult body. However, the recent advent of stem cell-based therapy for tissue repair and regeneration provides promising treatments for a number of neurodegenerative pathologies and other neurological disorders. Stem cells are capable of self-renewal and differentiation to generate a variety of mature neural cell lineages. Transplantation of such cells can be utilized as a clinical tool for reconstituting a target tissue, thereby restoring physiologic and anatomic functionality. The application of stem cell technology is wide-ranging, including tissue engineering, gene therapy delivery, and cell therapeutics, i.e., delivery of biotherapeutic agents to a target location via exogenously supplied living cells or cellular components that produce or contain those agents (For a review, see Tresco, P. A. et al., (2000) Advanced Drug Delivery Reviews 42:2-37). The identification of stem cells has stimulated research aimed at the selective generation of specific cell types for regenerative medicine.
Cell transplantation to replace lost neurons is a new approach to the treatment of the neurological damage that results from a stroke. One obstacle to realization of the therapeutic potential of stem cell technology has been the difficulty of obtaining sufficient numbers of stem cells. Embryonic, or fetal tissue, is one source of stem cells. Embryonic stem and progenitor cells have been isolated from a number of mammalian species, including humans, and several such cell types have been shown capable of self-renewal and expansion, as well differentiation into all neurological cell lineages (Svendsen, C. V. et al. (1997) Exp. Neurol. 148:135-146; Freed, C. R. et al. (2001) New Engl J. Med. 344(10):-719; Burnstein, R. M. et al. (2003) Int. J. Biochem. Cell Biol. 36:702-713; Zhang, S-C. et al. (2001) Nat. Biotechnol. 19:1129-1133; Reubinoff, B. E. et al. (2001) Nat. Biotechnol. 19:1134-1140; Björklund, L. M. et al. (2002) Proc. Natl. Acad. Sci. USA 99(4):2344-2349). However, the derivation of stem cells from embryonic or fetal sources has raised many ethical and moral issues that are desirable to avoid by identifying other sources of multipotent or pluripotent cells.
Stem cells with neural potency also have been isolated from adult tissues. Neural stem cells exist in the developing brain and in the adult nervous system. These cells can undergo expansion and can differentiate into neurons, astrocytes and oligodendrocytes. However, adult neural stem cells are rare, as well as being obtainable only by invasive procedures, and may have a more limited ability to expand in culture than do embryonic stem cells.
Other adult tissue may also yield progenitor cells useful for cell-based neural therapy. For instance, it has been reported recently that adult stem cells derived from bone marrow and skin can be expanded in culture and give rise to multiple lineages, including some neural lineages (Azizi, S. A. et al. (1998) Proc. Natl. Acad. Sci. USA 95:3908-3913; Li, Y. et al. (2001) Neurosci. Lett. 315:67-70). Intrastriatal and intranigral grafting of other cell types, such as neurons derived from human teratocarcinoma, and human umbilical cord blood mononuclear cells have also been tested in animal models of Parkinson's disease (Baker, K. A. et al. (2000) Exp. Neurol. 162:350-360; Ende, N. and R. Chen (2002) J. Med. 33(1-4):173-180).
Postpartum tissues, such as the umbilical cord and placenta, have generated interest as an alternative source of stem cells. For example, methods for recovery of stem cells by perfusion of the placenta or collection from umbilical cord blood or tissue have been described. A limitation of stem cell procurement from these methods has been an inadequate volume of cord blood or quantity of cells obtained, as well as heterogeneity in, or lack of characterization of, the populations of cells obtained from those sources.
Thus, alternative sources of adequate supplies of cells having the ability to differentiate into an array of neural cell lineages remain in great demand. Further, no satisfactory method exists to repair the neural, neurological, and behavioral damage caused by strokes. Strokes can affect the motor system, rendering the patient with symptoms of hemiparesis or paralysis. Thus, a reliable, well-characterized and plentiful supply of substantially homogeneous populations of cells having the ability to differentiate into an array of neural cell lineages would be an advantage in a variety of diagnostic and therapeutic applications for neural repair, regeneration, and improvement, as well as applications for improvements in behavior and neurological function, particularly in stroke patients.